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AFSO 21: 95th MDG streamlines referral management process

  • Published
  • By Senior Airman Julius Delos Reyes
  • 95th Air Base Wing Public Affairs
EDWARDS AIR FORCE BASE, Calif. --  The 95th Medical Group streamlined Edwards' Referral Management Center's process during a rapid improvement event here April 14 to 17.

This was part of the 95th MDG's effort to capitalize on the Air Force Smart Operations for the 21st Century initiative.

Through Air Force Smart Operations for the 21st Century, the 95th MDG personnel reduced the referral management's process from 74 steps to 38, said 1st Lt. James Athnos, Tricare Operations and Patient Administration flight commander and team leader during the event.

"Our goal was to increase patient satisfaction," Lieutenant Athnos said. "We want to reduce the confusion for our patients and reduce our waste -- the unnecessary steps -- by 25 percent."

Staff Sgt. Kara Furaus, 412th Logistics Test Squadron logistics test evaluator, volunteered to participate in AFSO 21 event to provide her input as one of the patients.

During the three-day event, Sergeant Furaus was one of the 17 participants who performed a walk-through of the current referral management process. A mock referral was performed through the Armed Forces Health Longitudinal Technology Application system -- the Department of Defense's global electronic health record system for tracking patient records.

"Basically, our referral starts when the provider and patient meet, and it is determined that we can't meet their needs here at the clinic," Lieutenant Athnos said. "We have to send them to a specialty provider on- or off-base. It ends when that referring provider receives result of whatever they were referred to."

With the current system, Sergeant Furaus said she had to take her primary provider's consultation, go to somebody else's office, fill out some paper work, wait for them to call her and schedule an appointment.

"The current system is a bit frustrating for me as a patient," she said. "There are too many visible steps to the patient."

That was just the tip of the iceberg because the referral management's 74 steps, which the team identified, also include processes for primary providers, specialty providers and the RMC itself.

The paper system really has been the factor in slowing down the referral management process. Some of the organizations involved in the RMC are doing duplicate steps, which were because of policies and contract obligations.

Multiple systems are also being used for referrals, and not every technician does a referral the same way, Lieutenant Athnos said.

"What AFSO 21 was able to do for RMC is to find where that 'fat' is, so we can trim it and get rid of it," he said.

"Our goals are to reduce waste, add value for our customer and become more efficient in our business," said Chief Master Sgt. David Gilmore, 95th MDG superintendent and AFSO 21 level I facilitator. "As the team went through the current process, they looked at every step -- all 74 of them. Through the eyes of the customer, they evaluated these steps."

During the event's walk-through, the team mapped the process to identify the steps that are value added, non-value added and non-value added but required.

"We had everybody who has contact with the referral system involved including patients, doctors, nurses, RMC staff and health management support contractors," Chief Gilmore said. "The team really came together. Nobody had more voice than another person. We all had one vote."

Looking at the process, the team came up with a solution by going completely electronic, Lieutenant Athnos said.

"We got rid of our paper-based products," he said. "That alone eliminated needless steps. Through AFSO 21, we were also able to look for one specific system that all technicians can use."

With all the unnecessary steps identified, the team streamlined the process from 74 to 38 steps -- eliminating 49-percent of the process.

"The biggest thing is creating more value for the patients," Chief Gilmore said. "We streamlined the process, reduced the steps and removed the confusion on how to get a referral."

The 95th MDG will slowly start implementing some of its newer processes.

"It will take some time for full implementation, but the change starts immediately," Lieutenant Athnos said. "We have many tasks varying from changing the way we direct patients to RMC to rewriting the standard operating procedures for RMC technicians. Basically, we want it to be computerized from the check-in to the actual referral process."

Since the RMC problems are not only within Edwards but also across the Air Force, the 95th MDG is sharing their findings through the Continuous Process Improvement-Management tool.

"This is an AFSO 21 tool that when an organization goes through an event, they have the ability to share it across the Air Force," Chief Gilmore said. "We did this knowing that it's not just for us but also for everybody."

Chief Gilmore said AFSO 21 allows the Air Force to do "less with less."

"AFSO 21 is really about cultural change where we look for better ways in doing business by reducing waste, giving value to our customers and becoming efficient and effective in the work we do," he said.